Evaluation of the SEVERITY of FACIAL and GENERAL TRAUMA in child and adolescent victims of traffic accidents.

•Evaluation of the FISS and TRISS SpO2 to obtain greater rigor in a standardized epidemiological profile of injury severity.•More accurate determination of trauma severity in child and adolescent victims of traffic accidents for improved urgency and emergency care.•Relation between the scales allows for better decisions on patient hospitalization, adequate treatment and the prevention of irreversible injuries.

A novel guide for minimally invasive genioplasty.

Mentoplasty or genioplasty is a simple procedure to enhance facial aesthetics. While usually considered simple, it might present certain difficulties during execution, especially when a minimally invasive approach is preferred. Drilling and cutting guides are a valuable tool to overcome such challenges but usually require larger incision and dissection to allow adequate positioning and bone rigid fixation. In this article, we describe a novel guide design that permits adequate bone repositioning while preserving minimally invasive protocols.

In vitro mechanical test of grid plates for mandibular angle fractures.

This study evaluated, by mechanical testing, the strength of four-hole grid plates used for mandibular angle fracture fixation. Much has been discussed about the treatment of mandibular fractures with straight or curved plates. However, there are few studies about the use of grid plates. The geometry of such plates provides three-dimensional stability, resistance against torque associated with a low profile. Ninety polyurethane hemimandibles were used as substratum. The hemimandibles were divided into nine groups and fixation of the fractures was performed varying the type and position of plate and type of screw. An intact hemimandible group was used as control. It was possible to observe that plates positioned at the tension zone present the highest load values, both for dislocations of 3 and 5 mm. There was no statistical difference when plates with or without an intermediate bar were tested. The locking screws were more efficient than the non-locking screws when the plates were positioned at the neutral zone. Results allowed us to conclude that grid plates installed at the tension zone presented greater mechanical efficiency. If grid plates are positioned at the neutral zone, they should have an intermediate bar and be fixed with locking screws.

Early Pediatric Multiple Facial Fractures Treatment With Resorbable Fixation.

ABSTRACT: The facial skeleton in pediatric patients can undergo several changes during development, according to their growth zones and the traumas they suffer. Thus, some of these traumas can lead to multiple complications if not treated properly. Epidemiology can vary according to the social, cultural, and environmental aspects of each individual. Therefore, each case must be treated individually, and it is important to consider age-specific aspects, such as the high osteogenic potential, which leads to faster bone healing. The use of resorbable fixation materials in facial fractures of pediatric patients is widespread, with good acceptance and great advantages over conventional titanium materials, mainly for the elimination of a second surgery to remove the materials. The present study aims to report a series of clinical cases of infants, who suffered trauma and evolved with fractures in the facial bones. Surgical treatment was instituted to reduce and fix fractures, using the resorbable system. Patients are followed up with periodic outpatient follow-up visits and have a good case evolution.

Ossifying fibroma in the maxilla and orbital floor: report of an uncommon case.

Benign fibro-osseous lesions occur when normal bone is replaced by cellular fibrous connective tissue and mineralized structures. One rare type of these lesions is the ossifying fibroma (OF). The aim of this study is to report an unusual case of OF in a 57-year-old female. Physical examination showed facial asymmetry without any tenderness, fluctuation, ocular pain, or ophthalmoplegia. Imaging exams revealed a solid mass involving the left maxilla and orbital floor. Surgical resection was performed without any complications or sequelae, and the histopathological results confirmed OF. Although recurrence is rare in this condition, the patient remains under follow-up.

Dentofacial deformities and the quality of life of patients with these conditions: a comparative study.

OBJECTIVES: The aim of the present study was to evaluate the quality of life of patients with dentofacial deformities and of patients subjected to orthognathic surgery to compare their results with those of patients who have no dentofacial deformity by applying the Orthognathic Quality of Life Questionnaire (OQLQ). STUDY DESIGN: Three groups of patients were interviewed, and the OQLQ instrument was applied to them by one examiner. RESULTS: Results showed statistical differences between groups and suggested that patients with no deformity and those subjected to orthognathic surgery have better quality of life compared with those with facial deformity. CONCLUSIONS: Orthognathic surgery with the consequent dentofacial correction seems to have a positive effect on quality of life.

Apparent Inadequate Fixation Due to Improper Radiographic Angulation.

Computed tomography is shown as an alternative important aid for diagnosis and postoperative evaluation in the maxillofacial region.

Adhesives based on butyl-cyanoacrylate for fixation of autologous bone graft: Pilot study in rabbits.

BACKGROUND/AIM: Injuries to bone during trauma may require bone grafts and/or fixation to ensure optimal healing. Autologous bone grafts are still very common, but little data exist regarding the most effective means of fixation of such grafts. The aim of this study was to compare the fixation of autologous bone grafts with titanium screws and adhesives based on n-butyl-cyanoacrylate. MATERIAL AND METHODS: Twenty adult rabbits were used. In group I, the graft was fixed with titanium screws (in one side of the animal head), while in groups II and III (in other spots in the same animal head), the graft was fixed with adhesive Tissuacryl® and Histoacryl®, respectively. The animals were sacrificed on post-operative days 7, 15, 30, 60, and 120. Histological and histomorphometric analyses were performed. RESULTS: Inflammatory reactions were observed in all groups at 7 days. At 15 days, group I showed no inflammatory reaction. There was new bone formation in group I at 30 days and at 60 days in groups II and III. After 120 days, the grafts were completely incorporated in group I and partially incorporated in groups II and III. Groups II and III presented less graft resorption at the final evaluation: 32.58 (±10.22) and 34.75 (±8.25), compared to 26.58 (±6.48) for group I (P=.001). CONCLUSIONS: The adhesives were compatible when they were in contact with bone structures, and they were effective in fixing the grafts. Groups II and III had less graft resorption.

Mandibular angle fractures: a comparative study between one- and two-plate fixation.

BACKGROUND/AIM: The mandibular angle fracture is a challenging fracture to manage. Over time, the literature has shown many types of treatment modalities and different kinds of internal fixation. The aim of this study was to evaluate the outcomes and complications of mandibular angle fractures managed by Champy's technique and two-plate fixation, over a period of 20 years. MATERIAL AND METHODS: The files of 149 patients with 155 angle fractures fulfilled the inclusion criteria and were chosen for this study. Data were collected regarding gender, age, race, date of trauma, addictions, etiology, signs and symptoms, fracture management, and complications. RESULTS: Prevalence was higher in males (82%), Caucasians (62%), and during the third decade of life (62%). Mean age was 26.5 years. The main cause was interpersonal violence, and the mean follow-up period was 232 days. The main signs and symptoms were pain, edema, and mouth-opening restriction. The most often associated fracture involved the mandibular condyle, and the most common complication was infection. CONCLUSION: There was no difference between the two modalities of treatment. However, the one-plate fixation technique had fewer complications.

Evaluation of Nasal Obstruction in Various Sagittal Skeletal Deformity of Jaws.

Nasal obstruction (NO) is a common symptom present in 25% of the general population, which significantly interferes with the quality of life. The different facial profiles and malocclusion patterns could be associated with the degree of NO. In order to evaluate the nasal function in patients with different facial morphology patterns, the authors developed a prospective study in which 88 patients from a dentofacial deformities center were included. These patients were submitted to fibrorhinoscopy (Mashida, ENT PIII) with a 3.2-mm cannula under topical anesthesia to evaluate septal deviation, inferior and medium turbinates, and pharyngeal tonsils. The 88 patients included in the study were divided into 3 groups according to the classification of the facial profile, distributed as follows: 32 class I, 28 class II, and 28 class III; the data collected was statistically analyzed by analysis of variance and the results are shown. The patients included in this study presented similar prevalence of NO with the reduction of airway function efficiency. Although it was not a statistically different, the group II presented higher mean Nasal Obstruction Syndrome Evaluation scores.

Evaluation of Three Different Osteosynthesis Methods for Mandibular Angle Fractures: Vertical Load Test.

The aim of this study was to evaluate the mechanical behavior of different rigid fixation methods in mandible angle fractures. Three different plates were tested: one 4-hole grid miniplate, one 8-hole curved grid miniplate, and one 4-hole straight miniplate.For the loading tests, 30 polyurethane hemimandibles sectioned at the angle area to simulate a simple angle fracture were used: 10 hemimandibles for each group. The mechanical evaluation revealed that the straight plate positioned at the tension zone presented the best results in supporting vertical loading in the predefined displacement moments of 1, 3, and 5 mm. Regarding the grid plates, there was no statistically significant difference between the smaller and the larger plate.According to this sample, the straight plate positioned in the tension zone presented better results than the other 2 different grid plates positioned at the neutral zone.

Cone-beam evaluation of pharyngeal airway space in class I, II, and III patients.

OBJECTIVES: The purpose of this study is to make a 3-dimensional (3-D) evaluation of the pharyngeal airway space (PAS) in patients with class I, II, and III malocclusion. STUDY DESIGN: Sixty patients were evaluated. The patients were divided in 3 groups according to their occlusion classification. The volume and area of PAS were evaluated using the software Dolphin 3-D Imaging in the preoperative period for orthognathic surgery. RESULTS: PAS volume and area were influenced by different patterns of malocclusion. The mean volume and area for class III patients were statistically bigger than for classes I and II patients (P < .001). There was also a significant difference for volume values between class I and II patients, being the bigger volume for the class I patients (P < .05). CONCLUSIONS: It was possible to conclude that the class III patients presented a bigger PAS compared with classes I and II patients.

Pharyngeal airway space cephalometric evaluation in transverse maxillary deficient patients after SARME

Aim: To evaluate prospectively the upper airway of 16 patients submitted to surgically assisted rapid maxillary expansion. Methods: Volumetric tomography acquisitions were done preoperatively (T1) and after six months postoperatively (T2), the slices were obtained from the hard palate to the third cervical vertebra (C3), the images were imported and reconstructed in the Dolphin software for 2D definition of the upper airway. A cephalometric radiograph was generated by the software, the cephalometric points were traced at T1 and T2 for all patients in a dark environment always by the same operator and the Arnett-Gunson FAB Surgery analysis was applied. Results: A statistically significant reduction in area (p=0.03) at the level of the nasopharynx was observed, while at the oropharynx and hypopharynx it showed no statistical difference between T1 and T2. Conclusions: The area in the nasopharynx level presented a statistically significant decrease, however, despite the area decrease at this point, the patients seem to do better, and thus, this area decrease may not be clinically significant.

Maxillofacial infection. A retrospective evaluation of eight years

AIM: To evaluate medical records from patients who had maxillofacial infections between August 2002 and May 2010. METHODS: Analysis of 157 patients' data looking for epidemiology, causes of the infection, type of treatment established and complications. RESULTS: 113 patients had odontogenic infections and 44 had non-odontogenic infections. The white ethnicity was the most affected (64.33%), prevailing the men (53.5%). The odontogenic infections occurred mostly at the mandible (55.74%), involving the posterior teeth (82%). Dental decay was the main etiology (90.90%). The most affected facial anatomic region was the submandibular (42.85%). Surgical treatment was required in 76% of the cases. CONCLUSIONS: Maxillofacial infections should be treated as soon as possible. Even without culture and antibiogram results, it was possible to treat the infection and to reestablish tissue function...

Inferior alveolar nerve function after sagittal split osteotomy by reciprocating saw or piezosurgery instrument: prospective double-blinded study.

PURPOSE: The aim of this prospective study was to objectively evaluate inferior alveolar nerve (IAN) sensory disturbances in patients who underwent sagittal split ramus osteotomy (SSRO) by comparing 1 side treated with a reciprocating saw with the other side treated with a piezosurgery device. MATERIALS AND METHODS: Clinical evaluation of IAN sensory disturbance was undertaken preoperatively and at 1 week, 4 weeks, 2 months, and 6 months postoperatively in 20 patients who underwent SSRO at the Division of Oral and Maxillofacial Surgery, Araraquara Dental School, São Paulo State University. The 20 patients were examined at all periods for IAN functionality by Semmes-Weinstein testing; neither the patients nor the examiner knew which side was treated using piezosurgery or a reciprocating saw. RESULTS: The mean age of the patients was 28.4 years (range, 20 to 48 yr). Before surgery, no patient had impaired function of the IAN in any of the 8 zones in the mental and inferior lip areas. All patients reported feeling the first monofilament at the time of the preoperative test. Seven days postoperatively, all patients reported some kind of altered sensitivity in at least 1 zone evaluated. CONCLUSIONS: The results of this study suggest there was no statistically significant difference in the sensitivity of the labiomental area regarding the instrument used to perform the osteotomy. Future studies will focus on enlarging the sample and evaluating the results.

Comparison of compressive strength between three different plates for mandibular angle fractures fixation.

The present study aims to compare three types of internal fixation for fractures of the mandibular angle. Mechanical testing was performed on replicas of polyurethane hemimandibles sectioned at the angle region to simulate a fracture and fixed with three different hardwares. Fixation devices enrolled on this survey included the grid plates with and without an intermediate bar and the method described by Champy and colleagues in 1978 and the sample consisted of 10 hemimandibles for each group. Vertical loadings were applied on each hemimandible and recorded after a vertical displacement of 3 and 5 mm. Statistical analysis was made by means of the variance analysis (ANOVA) and the Duncan test with a significance level of 5%. The Champy technique showed a statistically significant increased resistance when compared to the grid plates after vertical displacements of 3 and 5 mm. The results of this survey suggest that the Champy technique, when compared to the grid plate positioned at the middle of the mandibular bone (placement site selected for this study), is more resistant than the grid plate and that the inclusion or not of an intermediate bar to the grid plates does not improve its resistance after linear vertical loadings.

Reabilitacão total de maxila com enxerto intraoral: relato de caso / Maxillary rehabilittion with intra oral bone graft: case report

A perda dentária e a doença periodontal frequentemente levam a um volume ósseo insuficiente para a instalação de implantes osseointegráveis. O enxerto com osso autógeno é considerado o padrão ouro para reconstrução dos defeitos ósseos residuais desses processos deletérios. Algumas técnicas cirúrgicas se utilizam de áreas doadoras extraorais ou intrabucais, dependendo da quantidade de tecido ósseo necessário, do respectivo planejamento cirúrgico protético e das condições sistêmicas do paciente. Os enxertos ósseos intrabucais são uma opção segura para devolver o volume ósseo em reabilitações menos extensas, apresentando baixa morbidade e mínimo desconforto pós-operatório. Dentre as áreas doadoras possíveis, destacam-se o ramo e corpo mandibular com osso predominantemente cortical; e o mento, que oferece tecido ósseo córticomedular. Os enxertos autógenos apresentam capacidade de osteogênese, osteocondução e osteoindução, o que os diferenciam de outros biomateriais. O objetivo deste estudo foi relatar um caso, no qual se fez o uso do enxerto de ramo mandibular para a reconstrução total da maxila de uma paciente edêntula, mostrando que mesmo áreas extensas podem ser reconstruídas com enxertos de origem intrabucal. Todos os passos que permitiram a reconstrução total da maxila com osso proveniente de área doadora intrabucal são elencados no decorrer do trabalho, culminando com um resultado extremamente satisfatório.

The early tooth loss and periodontal disease often leave inadequate bone volume for installation of osseointegrated implants. The autogenous bone graft is considered the gold standard for reconstruction of residual bone defects. Some surgical techniques can be performed, including extra or intraoral donor sites depending on the degree of bone loss, depending on surgical-prosthetic planning and general condition of the patient. The intraoral bone grafts offer a safe option to rebuilt bone volume in smaller rehabilitations, with low morbidity and minimal postoperative discomfort. Among the possible donor sites, the mandibular ramus and body, which offer predominantly cortical bone, and the chin area, which offers corticomedullary bone tissue, can be harvested. The graft will be suitable both in quantity and quality, preserving the capacity of osteogenesis, osteoinduction and osteoconduction, which differentiate autogenous grafts from other biomaterials. The aim of this study was to report a clinical case in which the mandibular ramus graft was used for total reconstruction of an edentulous maxilla, showing that even large areas can be reconstructed with grafts from intraoral origino Ali the steps that allowed the complete reconstruction of the maxilla done by an intraoral donor area are listed in the text, culminating in an extremely satisfactory clinical result.

Estudo microbiológico comparativo entre sabão de clorexidina 2% e um novo sabão antisséptico para lavagem pré-operatória das mãos / Microbiological study comparing 2% chlorhexidine soap and a new antiseptic soap for preoperative handwashing

Objetivos: avaliar, por meio de estudo microbiológico, dois tipos de sabão propostos para a lavagem das mãos na preparação dos cirurgiões no tempo pré-operatório; comparando um sabão com potência antibacteriana já conhecida e um novo sabão formulado a partir de óleos vegetais. Materiais e métodos: Dez voluntários fizeram a escovação das mãos, segundo protocolos pré-estabelecidos para a rotina de medidas de antissepsia em centros cirúrgicos, com 3 sabões diferentes, sendo um sabão comum (comercial) sem poder antisséptico que serviu como Grupo Controle (I), um sabão de digluconato de clorexidina a 2% (Grupo II) e um novo sabão feito a partir de óleos vegetais numa concentração de 20%, que foi desenvolvido pelo Instituto de Química Unesp/araraquara no Grupo de Materiais Fotônicos, denominado surfactante a 20% (Grupo III). antes de lavar as mãos, logo após e uma hora depois com o uso de luvas cirúrgicas, foi realizada a coleta microbiológica. Resultados: Pelos resultados da aNoVa, verificam-se as seguintes diferenças significativas para o número de colônias bacterianas: entre tipos de sabão (menor número de colônias no sabão do Grupo II), entre tempos (redução do número de colônias no sabão do Grupo II) e efeito significativo da interação sabão versus tempo. Conclusão: o sabão de digluconato de clorexidina 2% mostrou um comportamento melhor em reduzir o número de colônias bacterianas das mãos imediatamente após a lavagem e continuou sendo superior após uma hora com o uso de luvas, quando comparado ao sabão de surfactante a 20%.

Objective: To evaluate, by means of a microbiologic study, two kinds of soaps suggested by surgeons for presurgical handwashing, comparing a well-known antibacterial soap with a new soap formulated from vegetable oils. Materials and methods: Ten volunteers performed handwashing according to previously established protocols for routine antisepsis in operating rooms using 3 different soaps: a common, commercially marketed soap, serving as the control group (Group 1), with no antibacterial characteristics; a soap with 2% chlorhexidine (Group II); and a new soap formulated from vegetable oils at a concentration of 20%, known as surfactant, which was designed by the Chemistry Institute (Unesp/Araraquara - Grupo de Materiais Fotônicos) (Group III). The microbiological samples were collected immediately before and after handwashing and one hour later with the volunteer wearing surgical gloves. Results: ANOVA revealed that the following significant differences are found in the number of bacterial colonies: between soap types (a smaller number of colonies in the Group II soap), between periods (reduction in the number of colonies in the Group II soap), and the significant effect of the soap versus time interaction. Conclusion: The 2% chlorhexidine soap performed better in reducing the number of bacterial colonies on the hands immediately after handwashing and after one hour with the use of surgical gloves, when compared to the 20% surfactant soap.

Clinical evaluation of the bicoronal flap in the treatment of facial fractures. Retrospective study of 132 patients.

The aim of the present study was to evaluate the postoperative complications of bicoronal flaps used to treat facial fractures. One hundred and thirty two patients that received bicoronal flaps for the treatment of upper and middle third facial fractures were called for clinical and radiographic examination. Minimum follow-up was 1 year and all patients had charts with adequate information about their perioperative care pertinent to the study. Results showed as complications hypoesthesia (17%), partial unilateral frontal motor deficit (11%), infection (3%), hypertrophic scars (3%), varying degrees of alopecia (18%), seroma or hematoma in the immediate postoperative period (5%). The flap provided wide surgical access to the upper and middle facial thirds with very few serious complications, most frequently allowing good aesthetic results.